ENC Health Currents: Cause Of Rare Polio-Like Illness Unknown

Dec 5, 2018

The state epidemiologist and a local physician weigh in on acute flaccid myelitis, a polio-like illness affecting children across the country.


According to the CDC, there have been 134 confirmed cases of acute flaccid myelitis in the United States so far in 2018.
Credit Centers For Disease Control And Prevention

Across the U.S., there have been 134 confirmed cases of acute flaccid myelitis reported in 2018.  Here in North Carolina, two confirmed and two probable cases  have been reported.  AFM mainly affects children ages two to eight years old.  The illness can have long-lasting and devastating neurological side effects including muscle weakness and paralysis. 

“Acute flaccid myelitis is very fear invoking because we don’t know what causes it, said Dr. Alex Dalzell, Clinical Associate Professor of Pediatrics at ECU’s Brody School of Medicine.  “We know it occurs.  We can describe it.  We can define it.  But we really don’t know what actually causes it.”

Acute flaccid myelitis affects the central nervous system, by disrupting the signals sent to the brain that control muscle movement.  More than 90 percent of AFM patients experience an upper respiratory infection at least a week prior to developing the illness, an indication that AFM is most likely viral.

“The problem is that we don’t know exactly which virus, if it’s a virus at all, that’s actually is causing this.   We’re making a lot of assumptions and a lot of it is based on the epidemiological curve.  It looks like the curve we see with enteroviruses.”

The Centers for Disease Control and Prevention started tracking AFM four years ago.  After testing 440 stool specimens from individuals with confirmed cases of AFM, they detected coxsackievirus A16, enterovirus D68 and enterovirus A71 in the spinal fluid of four patients.  Those viruses are likely what caused their AFM, however, no pathogens were detected in the other patients. 

“Polio itself has not been isolated, by the way, with any of these.  And people have looked for Polio with all these cases that have gone to the CDC.  So it’s not Polio but it acts like Polio. And so because of that, people think it’s going to be more like an enterovirus because Polio is a type of enterovirus.”

AFM cases in North Carolina as of 12/04/18. Data provided by the N.C. Department of Health and Human Services.

There’s currently no vaccine and no specific treatment for children who develop AFM.  Dr. Zach Moore, State Epidemiologist with the North Carolina Department of Health and Human Services the State is working with local physicians and the CDC to gather and report information on each case. 

“When we get reported cases, we confer with neurologists and experts at CDC to review their records to determine if they actually are AFM cases and that’s how each of these cases gets confirmed classified as a confirmed case.”

The State Department of Health and Human Services wouldn’t provide specifics on where this year’s cases were found in North Carolina.  Dr. Alex Dalzell said one case of AFM was reported at ECU’s Brody School of Medicine in 2014.

“We are equipped to help diagnose it… we know how to send off samples like to the state lab and the CDC if we need to.  But the supportive care is really what makes a difference. Your physical therapy, your occupational therapy, and also just helping them get through the acute illness.”

In November, the CDC established an acute flaccid myelitis task force to provide further investigation into the causes and effective treatments for patients with AFM.  The findings from the first report will be submitted at the December 6th meeting of the CDC’s Office of Infectious Diseases’ Board of Scientific Councilors in Atlanta.